Spirituality and its role in end-of-life care has emerged as a central issue in palliative care. There have been several recent studies of terminally ill cancer and AIDS patients by our research group demonstrating the central role of spiritual well being, and "meaning" in particular, in buffering against depression, hopelessness, and desire for hastened death. We have developed, manualized and piloted an 8-week Meaning-Centered Group Psychotherapy, designed to help patients with advanced cancer sustain or enhance a sense of meaning, peace, purpose, spiritual well-being and hope as they approach the end-of-life. Preliminary findings, based on an R21 grant, suggest that our Meaning-Centered intervention significantly reduced psychological distress and desire of hastened death, and significantly increased spiritual well-being and sense of meaning and purpose in life in a sample of advanced cancer patients. This project's overall aim is to conduct a randomized controlled trial of the efficacy of this new and-unique spiritually-based psychotherapy intervention for advanced cancer patients in enhancing psychological and spiritual well-being and quality of life. Specifically, we will examine the efficacy of Meaning-Centered Group Psychotherapy, compared to a standardized Supportive Group Psychotherapy, in enhancing spiritual well being and quality of life, and reducing psychological distress (anxiety and depression) and end-of-life despair (conceptualized as hopelessness, desire for hastened death, and suicidal ideation). In additon, we will examine clinical and demographic variables that may mediate or moderate treatment response to Meaning-Centered Group Psychotherapy in this population. 320 patients with stage IV solid tumor cancers will be randomized to receive 1 of these 2 interventions(160 patients randomized to each arm, anticipating an attrition rate of 40% would thus leave 96 patients per arm who complete the entire trial). Subjects will be assessed with a battery of self-report measure at 3 points: baseline/pre-intervention, post-intervention, and at 2 months post-intervention follow-up. This study will provide essential efficacy data on a novel and innovative psychotherapy intervention for patients with advanced cancer, incorporating spiritual (meaning-centered) elements, which holds great promise in the treatment of spiritual suffering at the end-of-life. [unreadable] [unreadable] [unreadable]